Alaska Mental Health Board, Alaska Department of Health and Social Services, Juneau, Alaska;
Section of Women's, Children's, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Alaska; and.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2020-1303.
With this study, we seek to understand the relationship between prebirth household challenges and the child's adverse childhood experiences (ACEs) score by age 3 in a statewide-representative birth cohort to inform primary prevention strategies.
We used a longitudinally linked data set from the Alaska 2009-2011 Pregnancy Risk Assessment Monitoring System, its 3-year follow-up survey, and multiple administrative data sources. Using this linked data set, we predicted an expanded ACEs score by age 3 using maternal reported prebirth household challenges.
The number of household challenges reported during the 12 months before or during pregnancy predicted ACEs score in a graded, dose-response manner. On average, reporting 4+ prebirth household challenges was associated with an ACEs score 4.1 times that of those reporting 0 challenges. Homelessness was associated with the greatest increase in ACEs score (relative rate ratio = 3.0). Prebirth household challenges that were independently associated with an elevated ACEs score in our final model included problems paying bills, someone close to the mother having a drinking and/or drug problem, homelessness, mother or husband or partner being in jail, husband or partner losing job, separation or divorce, and being checked or treated for anxiety or depression.
The accumulation and certain prebirth household challenges are strongly associated with the accumulation of childhood ACEs. Addressing and reducing household challenges during the prebirth period may serve as a primary point of ACEs prevention. Many evidence-based, multidisciplinary intervention strategies can and should be implemented in the prebirth period to strengthen the household unit before the introduction of a new child.
通过对全州代表性出生队列中 3 岁以下儿童的产前家庭挑战与不良童年经历（ACE）得分的关系进行研究，为制定初级预防策略提供依据。
我们使用了来自阿拉斯加 2009-2011 年妊娠风险评估监测系统的纵向链接数据集、其 3 年随访调查以及多个行政数据源。利用这个链接数据集，我们根据母亲报告的产前家庭挑战预测了 3 岁时扩展的 ACE 得分。
妊娠前或妊娠期间 12 个月内报告的家庭挑战数量与 ACE 得分呈梯度、剂量反应关系。平均而言，报告 4 个及以上产前家庭挑战与报告 0 个挑战的 ACE 得分之比为 4.1 倍。无家可归与 ACE 得分增加的相关性最大（相对危险比=3.0）。在我们的最终模型中，与 ACE 得分升高独立相关的产前家庭挑战包括：付账单有困难、母亲身边的人有饮酒和/或吸毒问题、无家可归、母亲或丈夫或伴侣入狱、丈夫或伴侣失业、分居或离婚、因焦虑或抑郁而接受检查或治疗。
家庭挑战的积累和某些产前家庭挑战与儿童 ACE 积累密切相关。在产前期间解决和减少家庭挑战可能是 ACE 预防的一个主要切入点。许多基于证据的多学科干预策略可以而且应该在产前期间实施，以在引入新孩子之前加强家庭单位。
